Despite the many advances in cancer treatments at major cancer centers, the answer to this question can be ‘no’.  You should consider traveling far away to get chemotherapy or radiation therapy when there is a clinical trial you would like to participate in.  Consider the marginal benefit and how innovative the treatment is at a center far away.  In the case of having surgery, traveling far to get an experienced surgeon makes sense if there is not one close to home.  But if the chemo or radiation you would be get at a hospital far away is the same chemo or radiation you would get close to home (i.e. same medication, same dose, same length… or at least very similar), then consider enjoying the comfort of home.

Family support is an important part of your cancer care, and when a recommended chemo or radiation regimen is one that you can have close to home, many oncologists will suggest having it done at a cancer center close to your family and support network.   Chemo and radiation can require frequent trips to the hospital (sometimes as many as 3-5 appointments per week).  In addition these treatments can sometimes be tiring.  Family and friend support can be helpful and sometimes critical.  This includes everything from rides to the hospital to verbal encouragement.  When getting a second opinion at a major cancer center far away from home, ask the oncologist if the recommended chemo or radiation regimen is the same or similar to what you can get closer to home.  Most importantly, consider the importance of your support network.

Expert Analysis Highlights:

• While conventionally, radiation treatments for lung cancer were given in 25-35 treatments, stereotactic approaches usually use only 1-5 treatments
• It was in patients with poor lung functions who are not candidates for surgery that stereotactic treatments were first explored
• Largest experiences in using this approach have been for patients with small tumors that are located away from central structures in the chest
• This technology is now becoming more widely adopted

Radiation has been used successfully to treat lung and other cancers for over 50 years.  During this period, there have been numerous technology advances that have allowed for higher dosages of radiation to be selectively delivered to the tumor while sparing dose to the normal tissues.  Most recently, these advances have led to “stereotactic” radiation treatments of lung tumors, which were nicely described in this video.  The goal of this type of treatment is to deliver very high ablative dosages of radiation in a very precise fashion to the tumor.  Multiple sites of beam entrances are used and all these beams then intersect within the tumor in order to provide this very high dose.  While conventionally, radiation treatments for lung cancer were given in 25-35 treatments, stereotactic approaches usually use only 1-5 treatments.

The largest experiences in using this approach have been for patients with small tumors that are located away from central structures in the chest.  Historically, these types of patients have been successfully treated with surgical resection.  Accordingly, it was in patients with poor lung functions who are not candidates for surgery that stereotactic treatments were first explored.  The results from these studies have shown the treatment to be highly effective.  The chance of eradicating the disease without the need for any surgical intervention is very high for appropriately selected patients.  Based on these data, there are now ongoing national/international studies to directly compare this new radiation approach versus surgical resection.

As suggested in the video, stereotactic treatments of lung cancer requires sophisticated technology including methods to manage the tumor motion due to breathing and image guidance to assure that the precise radiation delivery appropriately hits its target.  Equally important to the technology and equipment is the staff and physician experience.  Fortunately, this technology is now becoming more widely adopted and more centers are gaining experience with this new and promising approach.

Expert Analysis Highlights:

• For repeated injections and blood drawing during cancer treatment, you will likely need to have an implantable device for gaining access to your central veins
• Veins in the arms are usually used on a short-term basis, but they may be difficult, or even painful, to stick into repeatedly
• A range of products give access to the larger veins without causing pain from repeated injections or damage to these veins
• CR Bard Company has a nice website for patients who are being considered for an implantable device

The video segment here shows how a pediatric patient can have his chemotherapy administered without much discomfort, and without risking damage to his veins due to repeated injections. Whether you are an adult or a child with cancer requiring repeated injection or infusion of drugs, you will likely need to have an implantable device for gaining access to your central veins.

Why? Because administering drugs or other agents by intravenous infusion over a long period, or drawing repeated blood samples, can be a painful and difficult ordeal for patients and the healthcare team, especially when the patient is a child. Veins in the arms are usually used on a short-term basis, but they may be difficult, or even painful, to stick into repeatedly. The veins can dry up (thrombosis) or even get inflamed or infected (thrombophlebitis). Even more difficult and painful is resorting to getting blood, or giving infusions, from veins in the neck or the legs. This is a last resort when the veins in the arms have “given out”. We also know that it’s not just the needle and sometimes the drugs themselves can cause damage to the vein.  So-called “sclerotic agents”, such as adriamycin, can cause damage to the veins and infiltrate into the surrounding tissues, causing great tissue damage.

One of the significant technical advances for the cancer patients is the range of products that give doctors and nurses access to the larger veins without causing pain from repeated injections or damage to these veins.  Your doctor will go over with you about the different kinds of venous access to a major vein going to the heart. In each circumstance, it involves some minor surgery to put these catheters in place. These options are an implantable (subcutaneous) port, an , or a peripherally inserted central catheter (PICC).

The CR Bard Company has a nice website for patients who are being considered for an implantable port. They also have some great booklets for children (in English and Spanish) that describe these catheters which can help the kids understand the process with clearer expectations of how they are used during treatment. As described in the booklet to parents: “By maintaining a matter-of-fact and positive attitude, you can help your child adjust favorably to his … [central line, implantable port, PICC line].” If you or a loved one is facing this procedure, talk to your doctor about the options that would be most appropriate in your circumstance.

I highly recommend these books for children to help describe and explain catheters:

For a children’s book about the implantable venous port, go to: http://www.bardaccess.com/pdfs/other/MC-0406-00_A_Port_For_Me_web.pdf

For a children’s book about the central venous catheter, go to: http://www.bardaccess.com/pdfs/other/MC-0404-00_My_Central_Line_Book_web.pdf

For a children’s book about the peripherally inserted central catheter, go to: http://www.bardaccess.com/pdfs/other/MC-0405-00_My_PICC_Line_web.pdf

This is an Oncology Podcast segment for women about preparing for hair loss and how to cover the head with wigs and scarves.

Here’s more information from our companion website, patientresource.net:

Hair loss from chemotherapy usually begins within 10-14 days after the start of treatment and gets worse within 1 to 2 months. In some instances, depending on the chemotherapy drugs, hair loss may begin with a sensation of the scalp itching, and within a few hours hair begins to fall out. Hair loss typically continues throughout treatment. Hair usually begins to grow back 4-6 weeks after the end of treatment. In general, hair grows back at a rate of about one-quarter inch per month.

It takes longer for hair to be lost during radiation therapy. Hair loss in the area being treated usually begins 2-3 weeks after the first treatment. All hair in that area falls out within about 1 week and may begin to regrow 3-6 months after treatment has ended. However, the hair loss may be permanent.

There are no effective ways to prevent the loss of hair during cancer treatment. Being gentle with your hair may help make your hair loss more gradual and improve the regrowth of your hair.

The best way to manage hair loss (medical term is alopecia) is to think about what will make you feel most comfortable with your appearance. Most people with cancer have found that it is easier to make that decision before treatment starts. Many women choose to wear a wig, but some women find wigs to be irritating or itchy. If you decide to get a wig, consider several factors.

Tips on Wigs
* Buy the wig before treatment begins or at the beginning of treatment — you can better match your hair color and texture
* Try on several different wigs to find one that you really like
* Consider buying two wigs, one for everyday use and one for special occasions
* If you can’t afford a custom wig, buy a standard (less expensive) wig and have it professionally styled
* Ask if the wig can be adjusted — your wig size can shrink as you lose hair
* Get a prescription from your doctor for the wig because it is often covered by health insurance (Prescription must state “skull prosthesis for hair loss caused by cancer treatment”)
* Contact your local branch of the American Cancer Society to learn about free wigs that have been donated by patients after they have completed treatment

Wearing a scarf, hat, or other type of head covering is also a choice. Your scalp may be tender from treatment (especially radiation therapy to the head), and a head covering can protect your scalp against cold and sunlight. If you do not wear a head covering, make sure to use sunscreen on your scalp when you will be outside.

Some people choose to cut their hair short so that hair loss will not be as traumatic when it falls out. Others shave their head completely before treatment begins. How you handle hair loss is a personal decision and the right choice is the one that makes you feel most comfortable.

Being Gentle To Your Hair
* Use a soft-bristle brush and/or a wide-toothed comb
* Wash hair with a gentle, pH-balanced shampoo (avoid shampoos with strong detergents, chemicals, or frangrances)
* Do not use hair dryers, hot rollers, or curling irons
* Do not bleach or color your hair or get a permanent
* Avoid hair sytles that pull on the hair, such as braids or ponytails
* Sleep on a satin pillow case or put a hair net on to decrease friction

There are a number of resources that provide wigs and related products. The following is list of retailers provided by the American Cancer Society:

ChemoSavvy
PO Box 175
Green Mountain Falls, CO 80819
Toll-free number: 1-888-599-3560
Web site: www.chemosavvy.com
This company supplies wigs, hats, scarves, turbans, and accessories for women and children to consumers.

Doma Designs
426 East Bissell Avenue
Oil City, PA 16301
Toll-free number: 1-888-603-1206
Web site: www.domadesigns.com
This company supplies hats, bandanas, and accessories for women, men, and children to consumers.

Headcovers Unlimited
2020-C Anders Lane
Kemah, TX 77565
Toll-free number: 1-800-264-HATS (4287)
Web site: www.headcovers.com
This company supplies wigs, turbans, hats, and accessories for women, men, and children to consumers.

Look of Love International
1795-B Route 27 South
Edison, NJ 08817
Toll-free number: 1-800-526-7627
Web site: www.lookoflove.com
This company supplies wigs and accessories to consumers.

“tlc” Tender Loving Care®
PO Box 395
Louisiana, MO 63353-0395
Toll-free number: 1-800-850-9445
Web Site: www.tlcdirect.org
This company supplies wigs, hats, turbans, breast prostheses, bras, and other products to consumers. “tlc” is a part of ACS Products, Inc., an affiliate of the American Cancer Society.

Yako Corp DBA Hai’s Wigs
6474 Lake Worth Road
Lake Worth, FL 33463
Toll-free number: 1-888-471-2659
Web Site: www.ladywig.com
This is an online retailer that also has a physical store selling wigs and hair accessories. This company specializes in treatment-related hair loss.

Tender Loving Care®
PO Box 395
Louisiana, MO 63353-0395
Toll-free number: 1-800-850-9445
Web Site: www.tlcdirect.org
This company supplies breast prostheses, bras, wigs, hats, turbans, and other products to consumers. “tlc” is a part of ACS Products, Inc., an affiliate of the American Cancer Society

For treatment of advanced non-small cell lung cancer, Dr. Vincent A. Miller (MSKCC) describes study results that suggest the addition of erlotinib (Tarceva, OSI pharmaceuticals) to bevacizumab extends progression-free survival compared with bevacizumab alone. Damian McNamara of the Global Medical News Network (GMNN) reports from the annual meeting of the American Society of Clinical Oncology in Orlando.

Here is a nice clip from the UK for women that has some practical advice about sexual issues after cancer treatments. You should talk with your doctor before treatment begins to find out what to expect in terms of sexuality issues. If there are treatment options, make sure to talk about the side effects of each option. Ask your doctor when it is safe to resume sexual activity after treatment. During and after treatment, talk to your doctor or nurse if you have symptoms that interfere with sexual desire or sexual performance. If you feel uncomfortable talking with your doctor or nurse about your sexual symptoms, ask for a referral to an appropriate health care professional or support group.

Here’s more information from our companion website, patientresource.net:

There are a wide range of reasons for changes in sexuality during cancer treatment, and the reasons relate to the treatments themselves as well as to other side effects of treatment.

Surgery has a variety of effects on sexuality. Removal of all or part of a reproductive organ decreases hormone levels, which can lead to overall loss of sexual desire. Such surgery can lead to premature menopause in younger women, and may make sexual intercourse painful or difficult for younger and older women. Surgery in the pelvic area in men can damage the nerves leading to the penis, causing erectile dysfunction. Lastly, surgery that changes body appearance, as with removal of a breast or a testicle, can affect how a person feels about his or her body image. A negative body image can change how you feel about your sexual desirability.

Chemotherapy or radiation therapy to the pelvis may damage the ovaries in women or the testicles in men, both of which can reduce the amount of hormones produced. This loss of hormones may cause a loss of sexual desire in men and women, premature menopause in younger women, and erectile dysfunction in men.

The side effects of cancer treatments also play an important role in sexuality. Side effects such as fatigue, nausea and vomiting, pain, diarrhea, and mouth sores can substantially reduce a person’s interest in sex and his or her feelings of desirability.

Some treatments are available for physical sexual issues. For example, vaginal dryness can be treated with vaginal moisturizers and lubricants. Several drugs are available for erectile dysfunction, including sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis). These drugs may not be appropriate for every man, and men should talk to their doctors about the risks and benefits. Hot flashes in both women and men have been relieved with low doses of antidepressants such as fluoxetine (Prozac), venlafaxine (Effexor), duloxetine (Cymbalta), and paroxetine (Paxil). Management of side effects that interfere with intimacy can help you feel better overall, which may help you feel more desirable and more interested in sex.

Open communication with your spouse or significant other is key to maintaining a good intimate relationship. You and your partner should share concerns and fears. Talk about ways to be intimate other than with sexual intercourse. You should both understand that it is safe to have sex during cancer treatment (unless your doctor tells you otherwise). Counseling (individual, couples, and/or sex therapy) may be helpful.